Provider Demographics
NPI:1356348726
Name:YOKAN, NICHOLAS J (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:YOKAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9496
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83707-3496
Mailing Address - Country:US
Mailing Address - Phone:218-850-7177
Mailing Address - Fax:
Practice Address - Street 1:500 W FORT STREET
Practice Address - Street 2:BOISE VA MEDICAL CENTER
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-3501
Practice Address - Country:US
Practice Address - Phone:208-422-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM11949207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND714065Medicaid
SD6402120Medicaid
SD40962Medicare ID - Type Unspecified
SD6402120Medicaid
ND10084Medicare PIN
SD200046134Medicare PIN